Guide to Applying for EM Residencies

EM Residency

Besides knowing that EM is a wonderful career choice, there are a few things you need
to know up front. EM residencies are overseen by a Residency Review Committee or
RRC which is specific for EM and separate from other specialties. The RRC dictates
what a program/hospital must have, ie. trauma, burn, peds, as well as what procedures
etc. residents must perform for a residency to be accredited (and its very strict!).
This is important for you to know because you won't have to worry about whether or
not you will get a "good education" or get enough of this or that procedure. If a
program is accredited, you can rest assured that you will get a "good" education there.
This makes choosing a program somewhat easier in that you don't have to wonder if
you'd be a better doctor if you went to Vanderbilt or Cincinnati. What you will be
worrying about is where you want to live and which program you feel comfortable enough
to be in for 3 or 4 years, and whether you care about 3 vs. 4 years.

EM residencies can be 3- 4 years long with some being 2thru4 programs, which means
that you do a transitional or prelim year before starting your residency. The debate
on whether 3 or 4 years is better continues and it basically comes down to personal
preference. Most 4 year programs offer more electives, but a 3 year program is one
less year of residency and a year sooner of making money. Also some prefer a 3 year
program because they plan to do a fellowship after residency. There is also a trend
for those planning a career in academics to do 4 year programs over 3 years. Personally,
I didn't have a preference in regards to length of residency. My #1 program is a 4
year, #2-#4 are 3 year, and #5 is a 4 year program. I basically choose my rank list
based on where I felt most comfortable and where I felt like I would be most happy.

Grades

From what I can tell the first two years aren't really important...unless you failed
something, and honestly that might not be that big of a deal. I had very average first
two years. I definitely wasn't the top of the class and I am not anywhere close to
being AOA :) But anyway, what does matter is your clinical grades, particularly Medicine,
Surgery, and then Pediatrics. MOST IMPORTANT are your EM clerkship grades. So the
point is, don't be a slacker, but if you didn't get that "A" in OB/GYN or didn't really
care for MBOD or whatever they are calling Cell Biology now, don't lose hope.

Personally, I had "A's" in Medicine and Surgery and a "B" in Peds. My grade from my
EM rotation at Vanderbilt was a "B" (but they have this weird bell curve thing they
have to do...needless to say I don't think it hurt) and then I got an "A" from my
EM rotation at LSU, New Orleans.

EM Clerkships

First, DO AWAY ROTATIONS!!!!!!!! If you are interested in a particular program, try
to rotate there if possible. Doing an away rotation is good for many reasons. Away
rotations get you exposed to a program, its residents, and faculty; giving you a view
of the program you will NEVER get on a one or two day interview. Also, it is invaluable
to have a program know you and that you are a hard worker and that you get along with
not only the residents and faculty, but also the nurses, techs, and paramedics. (As
an aside, NEVER be rude or disrespectful to nurses or ancillary staff. They talk to
program directors too!)

Most people who rotate at a program are pretty much offered an interview. However,
I know of only one exception. A person who rotated at The Carolinas this past summer
didn't get offered an interview. But the MOST BENEFICIAL aspect of away EM rotations
is letters of recommendation!

Letters of Recommendation

Most programs require you to have at least 2 letters from EM faculty and sometimes
3, but you need at least 3 letters to complete your ERAS application. EM is a pretty
close knit family. Most everyone knows each other...either they went to residency
together, met at conferences and stayed friends, or maybe they are trout fishing buddies
as I found out in one interview. Point is, if you get a good letter from a well respected
program director it can make your application.

I got letters from Dr. Peter DeBlieux, Program Director at LSU, Dr. Micelle Haydell,
Assistant Program Director at LSU, and Dr. Keith Wrenn, Program Director at Vanderbilt.
And from what I've been told at interviews, they were all "excellent" recommendations.
GET LETTERS FROM EM PROGRAM DIRECTORS!

Board Scores

Boards scores....Unfortunately they do matter, but how much is the question. If you
rocked out a 240 on Step 1, more power to you :) But if you are like me and didn't
do as well.....passed but that's about it, then it's time to buckle down. You do need
respectable board scores in general for EM, I'd say above 200 at least. But, great
comebacks can occur. I did horribly on Step 1 (extenuating circumstances I'd be happy
to elaborate if you are interested) so to redeem myself I decided to take Step 2 early
and do much better.

I took off July, studied, and made a 221 on Step 2. Some programs commented or asked
about my Step 1 score during my interview, but they would then mention how well I
did on Step 2. Point is, do your best, but if Step 1 isn't your best then know that
programs DO look at Step 2 scores. And if you rocked Step 1, don't worry about taking
Step 2 till later in the year, but don't do like some and wait till April and have
such a hard time studying that you don't pass, that's BAD.

Applying for Residency

I applied to about 40 programs and got 13 interviews. I did 11 interviews and ranked
9 programs. I actually had 12 interviews scheduled but had to cancel one due to weather.

I didn't make it to my interview at East Virginia because of snow and couldn't work
out my schedule to be able to drive to Ann Arbor, but I interviewed everywhere else.
So, if you have questions about a particular program, I'd be happy to tell you what
I know.

MAKE SURE YOU SCHEDULE INTERVIEWS AS SOON AS YOU GET INVITED! I cannot stress this
point enough. Programs have a limited number of interview slots and offer more interviews
than they have spots available. Translation...if you wait a day to schedule, you may
end up on a waiting list or worse without an interview all together! So even if you
are driving everywhere like I did, best bet is to get a calendar and a map and try
to schedule interviews based on what days they offer and how close you may be to that
location from another interview. It is usually easier to reschedule an interview than
to wait and risk not getting one at all.

Overall, interviewing is a good experience. It is definitely exhausting. You don't
realize how much effort it takes to not only smile all day, but to also be on your
best behavior. I suggest you make an effort to spend time with the residents at your
respective programs. Definitely attend dinners if offered the night before an interview.
You really need to know if the residents are truly happy as well as if they are the
kind of people you could work well with. And if there is someone else in your class
doing EM interviews, try and stay in touch while interviewing. I found it very helpful
to have someone to compare notes with. Finally, have fun on your interviews, be yourself,
and answer questions honestly. If they don't like you for who you are, you definitely
don't want to end up at that program.

Ranking

Ranking is a tough task and you simply have to do it based on what feels right to
you. DO NOT rank a school that you would be unhappy to match with or where you think
you'd be miserable. "Murphy's Law" is that if you rank a program and don't want to
go there, you'll probably match there. Also, if you like a program over all others,
but don't think you have that good of a chance, rank it #1 anyway. The way the match
works is in favor of the applicant and I have heard several stories of students who
ranked there favorite as #1, but didn't expect to get in and they did. RANK THE PROGRAMS
IN ORDER OF WHERE YOU WANT TO BE, NOT WHERE YOU THINK YOU CAN GET IN.